Emergency Medicine Rotation Questions
and Answers Graded A
What are some differential Dx for Anaphylaxis - ANSWER -Angioedema
uticaria
asthma
epiglottitis
anxiety
S/S Anaphylaxis - ANSWER -Urticaria, erythema, pruritus
Nasal congestion, sneezing, coryza, cough, tachypnea
Sensation of throat tightness
Tachycardia, Hypotension
Treatment of Anaphylaxis - ANSWER -Epinephrine
Beta Agonist: Albuterol
Benadryl (H1 receptor blocker) tx cutaneous effects
Cimetidine (H2 receptor blocker) tx rxn and urticaria
Methylprednisolone 125mg IV 1x
Major risk factors for CAD - ANSWER -Age
Male
hyperlipidemia
hypertension
diabetes
smoking
Family hx
,personal hx
Cause of stable angina and key symptom - ANSWER -reduced coronary blood flow through a
fixed atherosclerotic plaques that narrow the blood vessel lumenia
Sx: chest pain easily relieved by rest or sublingual nitrates
What is unstable angina - ANSWER -Angina at rest lasting > 20min or new onset angina that was
previously undiagnosed
What is Prinzmetals angia - ANSWER -Pain is transient and atherosclerosis is minimal and pain
is caused by VASOSPASM
How do you treat prinzmetals angina - ANSWER -Nitrates and Calcium channel blockers
Deadly causes of chest pain - ANSWER -Tension Pneumothorax
Aortic Dissection
Pulmonary embolism
Unstable Angina
Myocardial infarction
Differential Dx for chest pain - ANSWER -CV: Aortic dissection, unstable angina, MI, pericarditis
Resp: Tension Pneumo, PE, Pneumonia
GI: Esophagitis, GERD, PUD, Cholecystits
MSK: Costochondritis
Neuro: Herpes Zoster
What is the workup for Chest pain - ANSWER -EKG
Serial cardiac enzymes
,Stress test
Echocardiogram
Coronary angiogprahy
CXR
Treatment (initial) - ANSWER -Assume possible Infarct
Aspirin, sublingual nitro, analgesics (Morphine), O2, Cardiac monitoring
On an exercise stress test what would indicate myocardial ishcemia - ANSWER -ST segment
changes, exercise intolerance, or decrease systolic BP
On an Echo what is a normal EF - ANSWER -55-75%
What is the definitive dx procedure for CAD - ANSWER -Coronary angiography
Lesions in the arteries/ obstruction usually do not present with sx until what % is blocked -
ANSWER -> 70%
What is the cause of an acute MI - ANSWER -Occlusive thrombus or prolonged vasospasm in
coronary artery
MC is Acute thrombus on a ruptured atherosclerotic plaque
S/S of MI - ANSWER -Chest pain that can radiated into the left arm, neck, or jaw
N/V
Dyspnea, lightheadedness
Diaphoresis, anxiety, "impending doom"
Tachycardia, pulmonary rales, hypotension, gallop rhythms (S4), mitral regurgitation 2ndary to
papillary muscle dysfunction
, the left main coronary artery branches off into what arteries and what parts of the heart to they
supply - ANSWER -Left main goes into
1. Left anterior descending artery- front of left side Heart
2. Circumflex artery- outer left side and back of the heart
The right coronary artery branches into what arteries and supplies blood to what parts of the heart
- ANSWER -Supplies blood to the Right Atrium, ventricle and the SA and AV nodes
1. Right posterior descending artery
2. Acute marginal branch
What are clues on an EKG that the dx is an MI - ANSWER -T wave inversion
ST segment elevation
Q waves
EKG Leads
Anterior
Septal
Inferior
Left lateral
Right ventricular
Posterior - ANSWER -Anterior: V2, V3, V4
Septal: V1 and V2
Inferior: II, III, aVF
Left lateral: I, aVL, V5, V6
Right ventricular: aVR, V4R
Posterior: V8, V9
and Answers Graded A
What are some differential Dx for Anaphylaxis - ANSWER -Angioedema
uticaria
asthma
epiglottitis
anxiety
S/S Anaphylaxis - ANSWER -Urticaria, erythema, pruritus
Nasal congestion, sneezing, coryza, cough, tachypnea
Sensation of throat tightness
Tachycardia, Hypotension
Treatment of Anaphylaxis - ANSWER -Epinephrine
Beta Agonist: Albuterol
Benadryl (H1 receptor blocker) tx cutaneous effects
Cimetidine (H2 receptor blocker) tx rxn and urticaria
Methylprednisolone 125mg IV 1x
Major risk factors for CAD - ANSWER -Age
Male
hyperlipidemia
hypertension
diabetes
smoking
Family hx
,personal hx
Cause of stable angina and key symptom - ANSWER -reduced coronary blood flow through a
fixed atherosclerotic plaques that narrow the blood vessel lumenia
Sx: chest pain easily relieved by rest or sublingual nitrates
What is unstable angina - ANSWER -Angina at rest lasting > 20min or new onset angina that was
previously undiagnosed
What is Prinzmetals angia - ANSWER -Pain is transient and atherosclerosis is minimal and pain
is caused by VASOSPASM
How do you treat prinzmetals angina - ANSWER -Nitrates and Calcium channel blockers
Deadly causes of chest pain - ANSWER -Tension Pneumothorax
Aortic Dissection
Pulmonary embolism
Unstable Angina
Myocardial infarction
Differential Dx for chest pain - ANSWER -CV: Aortic dissection, unstable angina, MI, pericarditis
Resp: Tension Pneumo, PE, Pneumonia
GI: Esophagitis, GERD, PUD, Cholecystits
MSK: Costochondritis
Neuro: Herpes Zoster
What is the workup for Chest pain - ANSWER -EKG
Serial cardiac enzymes
,Stress test
Echocardiogram
Coronary angiogprahy
CXR
Treatment (initial) - ANSWER -Assume possible Infarct
Aspirin, sublingual nitro, analgesics (Morphine), O2, Cardiac monitoring
On an exercise stress test what would indicate myocardial ishcemia - ANSWER -ST segment
changes, exercise intolerance, or decrease systolic BP
On an Echo what is a normal EF - ANSWER -55-75%
What is the definitive dx procedure for CAD - ANSWER -Coronary angiography
Lesions in the arteries/ obstruction usually do not present with sx until what % is blocked -
ANSWER -> 70%
What is the cause of an acute MI - ANSWER -Occlusive thrombus or prolonged vasospasm in
coronary artery
MC is Acute thrombus on a ruptured atherosclerotic plaque
S/S of MI - ANSWER -Chest pain that can radiated into the left arm, neck, or jaw
N/V
Dyspnea, lightheadedness
Diaphoresis, anxiety, "impending doom"
Tachycardia, pulmonary rales, hypotension, gallop rhythms (S4), mitral regurgitation 2ndary to
papillary muscle dysfunction
, the left main coronary artery branches off into what arteries and what parts of the heart to they
supply - ANSWER -Left main goes into
1. Left anterior descending artery- front of left side Heart
2. Circumflex artery- outer left side and back of the heart
The right coronary artery branches into what arteries and supplies blood to what parts of the heart
- ANSWER -Supplies blood to the Right Atrium, ventricle and the SA and AV nodes
1. Right posterior descending artery
2. Acute marginal branch
What are clues on an EKG that the dx is an MI - ANSWER -T wave inversion
ST segment elevation
Q waves
EKG Leads
Anterior
Septal
Inferior
Left lateral
Right ventricular
Posterior - ANSWER -Anterior: V2, V3, V4
Septal: V1 and V2
Inferior: II, III, aVF
Left lateral: I, aVL, V5, V6
Right ventricular: aVR, V4R
Posterior: V8, V9
